DIRECT DEPOSIT FORM FOR SUPPLIERS

PAG/RRP/DDF
2–ENG
NOV/10
UNIVERSITY OF PUERTO RICO
RIO PIEDRAS CAMPUS
FINANCE OFFICE
DIRECT DEPOSIT FORM FOR SUPPLIERS
SECTION 1 (TO BE COMPLETED BY SUPPLIER)
Supplier’s name:
Social security number:
Phone number: Work:
Mobile:
Fax:
Postal address:
E-mail address:
I hereby authorize the University of Puerto Rico, Río Piedras Campus, to verify and/or send this document to my financial
institution for certification of the information included on it. Also, I agree that payments of invoices on behalf of the
company/person stated above shall be made by direct deposit to the checking or saving account indicated below. I understand
that transactions through the Account Clearing House (ACH) are subject to federal regulations. I am responsible for notifying
the University of Puerto Rico, Rio Piedras Campus, of any address or account change in order to remain qualified for the direct
deposit payment method, and to continue receiving information from the institution regarding same.
The University of Puerto Rico, Río Piedras Campus, reserves the right to accept, deny or cancel the direct deposit payment
service. Any request for cancellation of service from the supplier company/person must be received, in writing, at the Finance
Office of the Río Piedras Campus, at least thirty (30) days before the cancelation date. In case the aforementioned supplier
should receive an incorrect payment in the account indicated below, I authorize the bank to debit this account as a corrective
action. Nevertheless, I shall return funds of incorrect payments should the bank’s corrective action not succeed. I authorize and
request the payment of invoices, made on behalf my company and/or person be deposited on the following account number:
Savings
Checking
Route or Transit Number
On Bank or Financial Institution
Branch:
(Name)
This request form should sign and send to:
University of Puerto Rico
Río Piedras Campus
Finance Office
PO Box 23308
San Juan PR 00931-3308
Once the direct deposit payment method begins, any claim for deposited payments on account should be made to the Pre-Audit
Division of the University of Puerto Rico, Río Piedras Campus.
Print or type name: _______________________________
Signature: ________________________________
Date: ______________________
SECTION 2(TO BE COMPLETED BY FINANCIAL INSTITUTION)
Name of financial institution
Route number:
Address
Depositor account title:
FINANCIAL INSTITUTION CERTIFICATION
I confirm the identity of the above-named payee(s) and the account number and title. As representative of the above-named financial institution, I certify that
the financial institution agrees to receive and deposit the payment above in accordance with state and federal rules.
Print or type Representative’s name
Signature of Representative
Telephone Number
THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE.
SUPPLIERS SHOULD FOLLOW INSTRUCTIONS ON THE OTHER SIDE OF THIS DOCUMENT.
Date
DIRECT DEPOSIT SERVICE FOR SUPPLIERS OF
THE UNIVERSITY OF PUERTO RICO, RIO PIEDRAS CAMPUS
Instructions:
1.
This form must be completed by typing or printing the information requested on it.
2.
Supplier’s responsibilities:
a.
Submit original form with Section 1, completed and signed to the Finance Office of Río Piedras Campus located
at Plaza Universitaria Building, Third Floor, Central Tower at Ponce de León Ave., or send it to the following
address:
University of Puerto Rico
Río Piedras Campus
Finance Office
PO Box 23308
San Juan PR 00931-3308
b.
c.
d.
e.
Keep a copy of the completed form for your records.
Notify the Finance Office of UPR Rio Piedras Campus in writing of any changes in the address or bank account .
Any changes to the bank account require the completion of a new direct deposit form. All subsequent payments
will be made by check until the completion of the required bank re-certifications and pre-notifications. If the
change is related to your contact information, as for example address, you can send a written notification to the
above address.
Return any funds resulting from any incorrect payment deposited in the account, that hasn’t been debited by the
bank institution as a corrective action.
Submit any request for cancellation of services by writing to the Finance Office of the UPR Río Piedras Campus
at least thirty (30) days before the requested cancelation date.
Benefits:
1.
Invoice payments can be deposited in accounts of the financial institutions of the “Automated Clearing House” system
of Puerto Rico:
Banco Popular de Puerto Rico
Banco Bilbao Vizcaya
Oriental Savings Bank
RG Premier Bank
Scotiabank de Puerto Rico
Western Federal Savings Bank
Cooperataiva Empleados UPR
Cooperativa Manuel Zeno Gandía
First Federal Savings Bank
First National Bank Boston
Banco Santander de Puerto Rico
Citibank Puerto Rico
Eurobank &Trust Company
Caribe Federal Credit Union
Cooperativa La Puertorriqueña
COOPACA
There may be other financial institutions on the ACH system that are not included on the above list.
3.
Credit transaction may be effective on date indicated by Río Piedras Campus to the financial institution It usually
takes the financial institution between two or three working days to deposit payment on the account. Nevertheless,
there may be special circumstances that can affect payment deposit by a financial institution.
4.
No more checks lost in the mail.
5.
There will be no charges related to direct deposit service.
Contact:
1.
If additional information is needed, please contact the Finance Office at 787-764-0000 x. 84360 or 787-764-1005 or by
fax 787-763-6190.